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Neurology > Neuropathies > Flashcards

Neuropathies Flashcards

1
Q

Presentation of a polyneuropathy generally

A

Diffuse, symmetrical. Long axons affected first - eg. to the feet. Then progresses proximally with legs and hands being affected.

Can be progressive, relapsing or transient

Can be sensory or motor or autonomic (or mixed)

‘Glove and stocking’ but stocking first

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2
Q

What is a radiculopathy?

A

Disease affecting the nerve roots eg. root compression

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3
Q

What is a plexopathy?

A

Disease affecting the brachial or lumbosacral plexus

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4
Q

Sensory symptoms of large myelinated fibre disease

A

Loss of fine touch, vibration and joint position sense (feel like cotton wool, difficulty discriminating textures and unsteady gait)

Paresthesiae - pins and needles

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5
Q

Sensory symptoms of small unmyelinated fibre disease

A

Loss of pain and temp - therefore painless burns and trauma and Charcot’s joints

Painful positive symptoms - burning sensations, dysaesthesia, hyperalgeisa, allodynia

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6
Q

Motor symptoms of neuropathy

A

Weakness - usually distal - clearing the kerb or opening jam jars

But can be proximal - climbing stairs and combing hair

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7
Q

What causes median nerve compression

A

Carpal Tunnel syndrome - entrapment at the wrist in the carpal tunnel

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8
Q

Symptoms of CTS

A

Tingling, pain and numbness in the hand
Waking at night and relieved by shaking over the side of the bed “wake and shake”
May extend up the arm
Wasting of thenar eminence if chronic

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9
Q

Tests to confirm CTS

A

Tinel’s Sign - taping the wrist over the nerve will may the pain/tingling worse and can give electric shock feeling

Phalen’s test positive - flex wrists and press against each other for 60seconds - tingling and numbness

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10
Q

Causes/associations of CTS

A

Idiopathic, hypothyroidism, 3rd trimester pregnancy (oedema), RA, acromegaly, sarcoid, neoplasms and benign tumours eg. lipomas

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11
Q

Treatment of CTS

A

Splint worn at night
Steroid injections locally
Surgical decompression

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12
Q

What causes ulnar nerve compression, what are signs and what is treatment?

A

Cubital tunnel damage - at elbow - elbow fracture
Or Guyon’s canal at wrist (no sensory symptoms) - handlebar palsy

Clawing of the hand - wasting of interossei and hypothenar muscles
Sensory loss - little finger and half of ring finger

Treatment with decompression and transposition (at elbow)

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13
Q

What causes radial nerve compression and what are the signs?

A

Compression against the humerus - eg. hanging arm over the back of the sofa
Causes wrist drop, weakness of brachioradialis and finger extensors

Sensory loss in the anatomical snuffbox

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14
Q

What is the name of lateral cutaneous nerve of the thigh compression, what happens and what are signs?

A

Meralgia paraesthesia

Entrapment under inguinal ligament

Causes burning, tingling and numbness of anterolateral surface of the thigh

Usually occurs in overweight people therefore lose weight

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15
Q

How do you get common peroneal nerve palsy? What does it cause?

A

Damage as winds around the fibular head - eg. cast, trauma, sitting cross-legged

Signs = foot drop, weak ankle dorsiflexion/eversion, sensory loss over dorsum of the foot and lateral calf

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16
Q

What causes damage to sciatic nerve and what are symptoms?

A

Fracture of femur or pelvis or pelvic tumours

Affects hamstrings and all muscles below the knee and loss of sensation below the knee laterally

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17
Q

What is mono-neuritis multiplex?

A

2 of more peripheral nerves are affected by neuropathy

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18
Q

Causes of mono-neuritis multiplex?

A

WARDS PLC

Wegeners
AIDS/amyloid
RA
DM
Sarcoid

PAN
Leprosy
Carcinomas

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19
Q

What is Guillan-Barre Syndrome?

A

Postinfective polyneuropathy

Inflammatory demyelinating polyradiculoneuropathy

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20
Q

Prevalence of GBS world-wide annual rate

A

3/100,000

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21
Q

What usually precipitates GBS?

A

Often follows 1-3 weeks after resp or GIT infection

Can also be associated with CMV

22
Q

Pathology of GBS

A

Infecting organisms antibody responses against peripheral nerves - possible molecular mimicry

23
Q

Symptoms of GBS

A

Weakness of distal limb muscles
Distal numbness
Progresses proximally over period of time
Loss of tendon reflexes
20% progress to respiratory failure and facial muscles also affected
Can get autonomic features

24
Q

Diagnosis of GBS

A

Clinical
Nerve conduction studies
CSF protein often raised

25
Q

What is Miller-Fisher Syndrome?

A

Type of GBS with ocular muscle palsies and ataxia

Antibodies against GQ1b - ganglioside in 90%

26
Q

Management of GBS

A

Ventilation if resp failure - thromboprophylaxis

If within 2 weeks - immunoglobulin

27
Q

What is Chronic Inflammatory Demyelinating Polyradiculoneuropathy?

A

Syndrome similar to GBS but with more prolonged onset and recovery

Rarely associated with preceding infection

Long-term immunosuppression with steroids or immunoglobulin

28
Q

How many diabetic patients get neuropathy

A

50% after 20 years - associated with poor glycaemic control

Different types occur - can be sensory/motor/autonomic

If autonomic get gastroparesis

29
Q

Neuropathy in renal disease?

A

Chronic renal failure with uraemia causes progressive sensorimotor neuropathy

Response to dialysis is variable but renal transplant is curative usually

30
Q

What thyroid disease causes neuropathy

A

Both hypo and hyper

31
Q

What neuropathy is associated with porphyria?

A

Predominantly MOTOR neuropathy - mainly proximal

32
Q

Paraneoplastic polyneuropathy

A

Malignant disease (esp. small cell carcinoma of bronchus) can cause sensory neuropathy and ataxia

Associated with anti-Hu/anti-neuronal antibodies

Can pre-date appearance of malignancy by months or years

33
Q

Neuropathy in amyloidosis

A

Predominantly sensory, painful neuropathy - distortion caused by deposition of amyloid around vessels in the nerves

Autonomic features are common

34
Q

Neuropathy in alcohol abuse

A

Up to 30% of all neuropathy cases

Slowly progressive, distal sensory loss, parasethesia, burning pains

Due to primary alcohol toxicity and also deficiency of vitamins

Also get myopathy and muscle weakness

Treatment by abstinence from alcohol, vitamin replacements

Ease pain with TCAs or gabapentin

35
Q

What vitamin deficiency is caused by alcohol?

A

Thiamine - B1 - Deficiency

36
Q

What deficiency causes sensory neuropathy when having TB treatment?

A

Pyridoxine B6 deficiency - therefore when taking isonizid for TB - pyridoxine is given - 10mg daily

37
Q

What is Charcot-Marie-Tooth Disease?

A

Group of hereditary motor sensory neuropathies

Present in puberty

Distal limb wasting - peroneal muscles (reverse champagne bottles)

Loss of sensation and reflexes too

Pes cavus and toe clawing

38
Q

Clinical features of radiculopathy

A

Pain - sharp, shooting, burning - in cutaneous distribution affected - or in the myotome

LMN signs

Sensory Loss

39
Q

What do you get with lateral cervical disc protrusion?

A

Severe pain in the upper limb
Most commonly C6-C7 disc affecting C7 root - therefore C7 dermatome/myotome (triceps, deep to scapula and extensor aspect of forearm - pain), weakness of these muscles, sensory loss - forearm and palm into middle finger

Loss of triceps jerk (C7)

40
Q

What do you get with lateral lumbar disc protrusion

A

L5 and S1 commonly affected

Low back pain and sciatica

Loss of sensation in dermatome

Ankle jerk lost - S1 reflex arc

Weakness of plantar flexion (S1) or great toe extension (L5)

Usually acute onset - following lifting, bending etc

41
Q

What do you get with central lumbar disc protrusion

A

Cauda Equina
Polyradiculopathy not myelopathy (normal with central protrusions)

Lower back pain 
LMN weakness 
Areflexia 
Sacral numbness 
Urinary retention and bowel dysfunction 
ED
42
Q

General management of radiculopathy with disc protrusion?

A

Analgesia and may resolve with rest

Can do decompressive surgery - urgent if central lumbar disc protrusion

43
Q

Features of Erbs Palsy

A

Waiters tip posture - sensory loss in C5/C6 distribution

Caused by falling on shoulder or traction on neck/shoulder at birth

44
Q

Features of Klumpkes Palsy

A

Caused by forced abduction of arm - trauma or at birth
Clawed hand - loss of intrinsic hand muscles and long flexors and extensors of fingers

Sensory loss in C8/T1 dermatomes

Horner’s syndrome

45
Q

What is neuralgic amyotrophy

A

Severe pain in plexus (muscles of shoulder - brachial neuritis)

Followed by rapid wasting of proximal muscles (demyelinating plexopathy)

Sensory symptoms are rare

Can also occur in lumbosacral plexus

46
Q

Pancoast tumour presentation

A 
Apical lung tumour 
C8/T1 most common 
Severe pain in arm 
Weak and wasted hand - sensory loss
Horner's syndrome
47
Q

What happens in thoracic outlet syndrome from cervical rib?

A

Compresses lower brachial plexus roots - C8/T1 - pain, wasting and sensory loss (thenar mostly - T1)
Horners syndrome possible

Can also cause subclavian artery/vein occlusion

  • Unilateral raynauds
  • Loss or radial pulse on abduction and external rotation of shoulder = ADSON’s SIGN

Neurological and vascular rarely occur together

48
Q

Lumbosacral plexus signs in upper plexus lesion and lower plexus lesion

A

Upper = weakness of hip flexion and adduction - anterior leg sensory loss

Lower = weakness of hamstrings and foot muscles - posterior leg sensory loss

49
Q

What does cervical spondylosis cause?

A

Progressive spastic quadriparesis with sensory loss below the neck

As flex and extend the neck, drags the cord over bony spurs

Limited painful neck movement - neck flexion may produce L’Hermittes sign

50
Q

Management of cervical spondylosis

A

Firm neck collar
Surgical root decompression

Transforaminal steroid injection - because nerve root inflammation may be causing pain

Neurology (10 decks)

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